Locking suture construct

ABSTRACT

A locking suture construct having suture material with a first end and a second end, each attached to a first body in a slidable manner, a constricting member formed in the second end of the suture material, and a bight in the suture material between the first end and the second end. The bight can be pulled through the constricting member around a second body to create a locking loop. The first end and the second end are passed through the locking loop. Pulling the first end increases a perimeter of the locking loop and moves the constricting member toward the second body. When the constricting member reaches the second body, pulling the first end reduces the perimeter of the locking loop and moves/rotates the constricting member around the second body toward the first body to hold the first body in relative position to the second body.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a divisional of U.S. patent application Ser.No. 15/630,215, filed on Jun. 22, 2017, now U.S. patent Ser. No.10/610,212, which claims priority to and the benefit of U.S. ProvisionalPatent Application No. 62/518,749, filed on Jun. 13, 2017, the entirecontents of which are hereby incorporated by reference.

BACKGROUND OF THE INVENTION Field of the Invention

The present invention is related to an adjustable locking construct forfixation of two bodies at a surgical/repair site and, more particularly,to an adjustable suture loop construct for fixing the relative positionof two bodies at a surgical/repair site.

Description of the Related Art

Sutures with traditional knots or knotless constructs are often employedfor reduction and fixation of two bodies in orthopedic surgery. Once thesuture is around the two bodies, the ends of suture are formed into atraditional knot, or held by the knotless construct, to keep the suturearound the two objects at a fixed length and able to support a load.Traditional knots depend on the tight, tortuous path created by pullingthe limbs of the suture material to keep the suture loop from growingunder load. However, once the knot is constructed, it is unable to berepositioned using the two ends of suture available. The construct isoften in a location such that other bodies may contact the knot, whichmay cause the knot to loosen. Further, if other bodies contact the knot,the knot may irritate surrounding tissue.

Knotless constructs work to improve upon knots with the ability to bequick to construct and reducible in size. Knotless constructs of areduced size limit the risk of any potentially irritating body whilemaintaining strength. Knotless constructs often depend on anotherclamping body separate from the suture, such as a “finger-trap”mechanism, or tension between the two objects to provide pressure on thesuture, or a combination of these factors to keep the suture loop fromgrowing under load. Clamping bodies add complexity to the construct andallow for additional points of failure. The “finger-trap” mechanismrequires tension across the axis of the “finger-trap,” which may slip iftension is not maintained across the axis. Changes in loading betweenthe two objects may fluctuate, or significant tension between the twoobjects may be undesirable and make pressure on the suture ineffectiveto keep the suture from slipping. While low profile compared totraditional knots, knotless constructs often have areas of increasedsize which can cause irritation.

Description of the Related Art Section Disclaimer: To the extent thatspecific patents/publications/products are discussed above in thisDescription of the Related Art Section or elsewhere in this disclosure,these discussions should not be taken as an admission that the discussedpatents/publications/products are prior art for patent law purposes. Forexample, some or all of the discussed patents/publications/products maynot be sufficiently early in time, may not reflect subject matterdeveloped early enough in time and/or may not be sufficiently enablingso as to amount to prior art for patent law purposes. To the extent thatspecific patents/publications/products are discussed above in thisDescription of the Related Art Section and/or throughout theapplication, the descriptions/disclosures of which are all herebyincorporated by reference into this document in their respectiveentirety(ies).

BRIEF SUMMARY OF THE INVENTION

Embodiments of the present invention recognize that there are potentialproblems and/or disadvantages with the conventional knot or knotlesssuture constructs. For example, knots and knotless constructs can belarge enough to cause irritation without a means for repositioning.Therefore, a need exists for a simple to use locking suture constructwith a means for repositioning, tightening and loosening the constructwithout releasing tension therefrom. Various embodiments of the presentinvention may be advantageous in that they may solve or reduce one ormore of the potential problems and/or disadvantages discussed herein.

The present disclosure is directed to an inventive configuration,structure, and resulting function of an adjustable locking sutureconstruct comprised of suture material with a first end and a secondend, each attached to a first body in a slidable manner, a constrictingmember formed in the second end of the suture material, and a bight inthe suture material between the first end and the second end. A lockingloop in the suture material is formed when the bight is passed throughthe constricting member around a second body.

When the locking suture construct is employed, a fixation loop secures afirst body in relative position to a second body. The fixation loopcomprises a fourth limb and a first limb. A positioning loop secures aconstricting member in first position relative to the first body. Thepositioning loop comprises a second limb and a third limb. The fourthlimb comprises the constricting member. The first limb and the secondlimb are threaded through the constricting member and form a lockingloop.

According to an another aspect, a method of securing a first body inrelative position to a second body includes (but is not limited to) thesteps of: providing a locking suture construct having suture materialwith a first end and a second end, each attached to a first body in aslidable manner, a constricting member formed in the second end of thesuture material, and a bight in the suture material between the firstend and the second end; pulling the bight through the constrictingmember around a second body to create a locking loop; passing the firstend and the second end of the suture material through the locking loop;pulling the locking loop while holding the first end of the suturematerial in a fixed position to increase a perimeter of the locking loopto a first predetermined size; pulling on the first end to decrease theperimeter of the locking loop to a second predetermined size smallerthan the first predetermined size; and after the locking loop reachesthe second predetermined size to move or rotate the constricting memberpast the second body toward the first body to a first position.

Suture material or sutures, as the terms are used and described herein,include monofilament or multi-filament suture as well as any othermetallic or non-metallic filamentary or wire-like material suitable forperforming the function of a suture. This material can include bothbioabsorbable and non-absorbable materials.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING(S)

The present invention will be more fully understood and appreciated byreading the following Detailed Description in conjunction with theaccompanying drawings. The accompanying drawings illustrate only typicalembodiments of the disclosed subject matter and are therefore not to beconsidered limiting of its scope, for the disclosed subject matter mayadmit to other equally effective embodiments.

Reference is now made briefly to the accompanying drawings, in which:

FIG. 1 is a perspective view schematic representation of a lockingsuture construct with an anchor according to an embodiment;

FIG. 2 is a perspective view schematic representation of a lockingsuture construct with an anchor according to an alternative embodiment;

FIG. 3A is a magnified perspective view schematic representation of anadjustable constricting member constricting member construct accordingto an embodiment;

FIG. 3B is a magnified perspective view schematic representation of anadjustable constricting member constricting member construct accordingto an embodiment;

FIG. 3C is a magnified perspective view schematic representation of alocking splice constricting member construct of according to anembodiment;

FIG. 3D is a magnified perspective view schematic representation of thelocking splice constricting member construct of FIG. 3C with a reducedlocking loop according to an embodiment;

FIG. 3E is a magnified perspective view schematic representation of thefixed constricting member of FIG. 17 according to an embodiment;

FIG. 3F is a magnified perspective view schematic representation of anadjustable constricting member construct according to an embodiment;

FIG. 3G is a magnified perspective view schematic representation of anadjustable constricting member construct according to an embodiment;

FIG. 4 is a side view schematic representation of the locking sutureconstruct shown in FIG. 1 loaded onto an inserter according to anembodiment;

FIG. 5 is a side view schematic representation of the locking sutureconstruct shown in FIG. 1 implanted in a bone hole via the anchoraccording to an embodiment;

FIG. 6 is a perspective view schematic representation of a control linethreaded through a constricting member around the tissue shown in FIG. 5according to an embodiment;

FIG. 7 is a perspective view schematic representation of a locking loopformed in the suture material according to an embodiment;

FIG. 8 is a perspective view schematic representation of the lockingsuture construct of FIG. 7 with a reduced constricting member accordingto an embodiment;

FIG. 9 is a perspective view schematic representation of a first end anda second end of suture material threaded through the locking loop ofFIG. 7 according to an embodiment;

FIG. 10 is an extended perspective view schematic representation of thelocking suture construct similar to FIG. 9 according to an embodiment;

FIG. 11 is a perspective view schematic representation of a reducedconstricting member in close proximity to the tissue according to anembodiment;

FIG. 12 is an extended perspective view schematic representation of thelocking suture construct of FIG. 11 with a reduced locking loopaccording to an embodiment;

FIG. 13 is a top perspective view schematic representation of thelocking suture construct of FIG. 12 according to an embodiment;

FIG. 14 is a perspective view schematic representation of theconstricting member and locking loop rotated toward the anchor accordingto an embodiment;

FIG. 15 is a top perspective view schematic representation of thelocking suture construct of FIG. 14 according to an embodiment;

FIG. 16 is a perspective view schematic representation of the lockingsuture construct of FIG. 14 with an excess portion of the first end andthe second end excised according to an embodiment;

FIG. 17 is a perspective view schematic representation of a lockingsuture construct with a threader through a fixed constricting memberaccording to an alternative embodiment;

FIG. 18 is a perspective view schematic representation of a control linepulled through the eyelet of the threader according to an alternativeembodiment;

FIG. 19 is a perspective view schematic representation of the threaderpulling the control line through the fixed constricting member accordingto an alternative embodiment;

FIG. 20 is a perspective view schematic representation of a locking loopcreated by pulling the control line through the fixed constrictingmember according to an alternative embodiment; and

FIG. 21 is a top perspective view schematic representation of thelocking suture construct with a locking splice construct as theconstricting member according to an alternative embodiment.

DETAILED DESCRIPTION OF THE INVENTION

Referring now to the drawings, wherein like reference numerals refer tolike parts throughout, there is seen in FIG. 1 an illustrativeembodiment of the locking suture construct 10 with a slidably attachedsuture anchor 2. A purpose of the locking suture construct 10 in theillustrative embodiment discussed herein is to secure the suture anchor2 in relative position to a tissue 18 via a fixation loop 30 with afixed size and tension, as shown for example in FIG. 14 (describedfurther below), where the suture anchor 2 can represent a first body (B)and the tissue 18 can represent a second body (A) (see, e.g., FIG. 15).

In accordance with multiple embodiments, the first body (B) can be asuture anchor as shown in FIGS. 1 and 2, a surgical button (for use in,e.g., ACL repair), or a bone such as the coracoid process (for use in,e.g., bone to bone or bone to soft tissue fixation), as long as thelocking suture construct 10 can be attached in an adjustable (e.g.,slidable) manner to the first body (B). In the depicted embodiment ofFIG. 1, for example, the suture anchor 2 can be an all-suture anchor,such as a Y-Knot® anchor (as should be understood and appreciated bythose of ordinary skill in the art in conjunction with a review of thisdisclosure). In an alternative embodiment shown in FIG. 2, the sutureanchor 2 can be a rigid suture anchor, such as the Revo® anchor orCrossFT® anchor (as should be understood and appreciated by those ofordinary skill in the art in conjunction with a review of thisdisclosure). Similarly, the second body (A) can be soft tissue as shownfor example in FIG. 14, or a tendon, a bone block, or a bone such as aclavicle (as should be understood and appreciated by those of ordinaryskill in the art in conjunction with a review of this disclosure).Notwithstanding these examples, the structure, configuration, use andfunctionality of the embodiments of the locking suture construct 10described herein are not dependent on the particulars of the first body(B) and the second body (A). Stated differently, the first body (B) andthe second body (A) can be any two objects, and the locking sutureconstruct 10 can generally be structured, constructed and function inthe same manner as described herein.

Referring back to FIG. 1, the locking suture construct 10 can include alength of suture material 6 having a first end or strand 12 and a secondend or strand 13. As shown, the suture material 6 can be threadedthrough a loop 8 in a control line 11 and then through the suture anchor2 (from right to left in FIG. 1) such that the first end 12 and thesecond end 13 of the suture material 6 are preferably relatively equalin length and parallel. Alternatively, any similar instrument (or noinstrument at all, e.g., a user's finger), can be used in place ofcontrol line 11 and perform all of the functions of control line 11 asdescribed herein and below (such as a gripper, a device with a hook, orany other grabbing or gripping device as should be understood by thoseof skill in the art in conjunction with a review of this disclosure) bygrabbing or catching bight 7 formed in suture material 6 (see, e.g.,bight 7 shown in FIGS. 1, 2, 4, 5, 6, 7, 8, 9, 10, 11, 17, 18, 19, 21).

The locking suture construct 10 can also include a constricting member,which can be fixed or adjustable. As described further below andillustrated in the Figures, each of the embodiments of the constrictingmember is formed as part of a structural intersection construct throughwhich other portions of the suture 6 and a control line 11 or a threader21 pass. Each constricting member embodiment is configured to movealong/rotate around fixation loop 30 to an optimal position asdetermined by a user, i.e., medical professional (compare, for example,the positioning of the constricting member in FIG. 12 with FIG. 14, andthe positioning of the constricting member in FIG. 13 with FIG. 15),while the fixation loop 30 preferably maintains a fixed size and tensionabout first body (B) and second body (A). The constricting member can beformed as an adjustable locking splice/constricting member 20 as shownin FIGS. 3A-3B, an alternative adjustable constricting member 20′ asshown in FIGS. 3C-3D, a fixed constricting member 20″ as shown in FIG.3E, another alternative adjustable constricting member 20′″ as shown inFIGS. 3F-3G, or any other similar enclosed boundary component (as shouldbe understood and appreciated by those of ordinary skill in the art inconjunction with a review of this disclosure).

Turning to FIGS. 3A-3B, schematic representations of an adjustableconstricting member 20 are shown. Adjustable constricting member 20 isformed of a loop created by the second end 13 of the suture material 6(or portion 4) being passed through itself in one direction or theother. The embodiment shown in FIG. 3A is configured such that secondend 13 moves to the right (is pulled) to shrink the size of the holeformed by adjustable constricting member 20. The embodiment shown inFIG. 3B is configured such that portion 4′ moves to the right to shrinkthe size of the hole formed by adjustable constricting member 20. Theadjustable constricting member 20 is the embodiment of the constrictingmember used in certain example figures illustrating the use andfunctionality of the constricting member, which is further detailedbelow.

Turning to FIGS. 3C-3D, schematic representations of a locking splice20′ are shown. Locking splice 20′ is a fixed constricting member, and isformed of a segment of hollow round suture 23 between voids 25 in thewall of a length of hollow round suture.

Turning to FIG. 3E, a schematic representation of another fixedconstricting member 20″ is shown. The fixed constricting member 20″ isformed of a section of hollow round braided suture material 23 betweensections of flat braided suture material 24.

Turning to FIGS. 3F-3G, schematic representations of another adjustableconstricting member 20′″ are shown. The adjustable constricting member20′″ is formed of a loop created by the second end 13 of suture material6 being passed through a section of round suture material 23 betweensections of flat suture material 24. As with the adjustable constrictingmember 20′, the perimeter of the adjustable constricting member 20′″ isreduced when the threaded piece of suture material, either the threadedlimb 4 or second end 13, is pulled.

Referring now to FIG. 4, there is shown an illustrative embodiment ofthe locking suture construct 10 loaded on a suture anchor inserter 14.The suture anchor 2 is loaded onto the inserter 14, such as a Y-Knot®inserter (as should be understood and appreciated by those of ordinaryskill in the art in conjunction with a review of this disclosure) suchthat the first end 12 is on a first side of the inserter 14 and thesecond end 13 is on a second side of the inserter 14. In the depictedembodiment, the inserter 14, suture anchor 2, and the locking sutureconstruct 10 are shown in a pre-bone installation position andconfiguration, and both the control line 11 and the first end 12 are onthe first side of the inserter 14. However, in this position andconfiguration, the control line 11 may alternatively be on the secondside of the inserter 14 with the second end 13.

Once the locking suture construct 10 is loaded onto the inserter 14, theinserter 14 can be used to implant the suture anchor 2 within a bonehole 26 formed in bone 16, as shown in FIG. 5. In the illustrativeembodiment, the suture anchor 2 is placed within the bone hole 26 suchthat the first end 12 of suture material 6 and the control line 11 areon a first side of a tissue 18. As similarly stated above, the controlline 11 may alternatively be on the second side of the tissue 18 withthe second end 13 of the suture material 6.

FIGS. 6-16 depict the steps to alter and fix the relative distancebetween the suture anchor 2 and the tissue 18 using the locking sutureconstruct 10. First, in FIG. 6, the control line 11 is threaded throughthe constricting member 20. As shown in the depicted embodiment, thecontrol line 11 is fed through the constricting member 20 formed on thesecond end 13 positioned above the tissue 18. Then, as shown in FIG. 7,the control line 11 and loop 8 and a portion of suture material 6 arefully pulled through the constricting member 20, creating a locking loop15 with portion of the suture material 6 that was pulled throughconstricting member 20. As the perimeter of locking loop 15 grows perthe continued pulling of the control line 11, the constricting member 20is configured to move toward the tissue 18.

Although shown expanded for clarity, the constricting member 20 in FIG.7 is preferably actually tight around the locking loop 15, as shown inFIG. 8, pursuant to pulling on second end 13 (in the upward direction asshown in FIG. 8). Next, referring now to FIG. 9, the first end 12 andthe second end 13 of the suture material 6 are passed through thelocking loop 15. FIG. 10 depicts the first end 12 and the second end 13pulled through the locking loop 15, where the constricting member 20 isshown in an expanded configuration for clarity of the positioning ofeach of the reference components.

Referring now to FIG. 11, the first end 12 and the second end 13 areshown passed through the locking loop 15, which had previously beenenlarged, moving the constricting member 20 against the tissue 18 asdescribed above. With the constricting member 20 in close proximity tothe tissue 18, the first end 12 is pulled to reduce the perimeter of thelocking loop 15 to a minimum perimeter, as shown in the views of FIGS.12 and 13. When the locking loop 15 is reduced, the locking loop 15squeezes, pinches or “strangles” the first end 12 and the second end 13to obtain a minimum working perimeter (where, for example, the innersurface of the locking loop 15 preferably fully contacts and appliespressure to the first end 12 and the second end 13; and/or where theinner surface of the locking loop 15 squeezes down to a point where if1′ and 2′ are pulled separately/individually, they do not freely oreasily move/slide through constricting member 20—see, e.g., FIG. 3D—asshould be understood by a person of ordinary skill in the art inconjunction with a review of this disclosure). Tension is preferablymaintained on the control line 11 while reducing the locking loop 15(per the pulling of first end 12) until the locking loop 15 has aminimum working perimeter. Once locking loop 15 reaches the minimumworking perimeter, fixation loop 30 is configured to maintain its sizeand tension about first body (B) and second body (A).

With reference to FIGS. 14-15, if the first end 12 is continuouslypulled after the locking loop 15 has reached a minimum perimeter, theconstricting member 20 is configured to and begins to move/rotate towardthe suture anchor 2 (while fixation loop 30 preferably still isconfigured to maintain its size and tension). As shown in FIGS. 14-15,as compared to FIGS. 12 and 13, respectively, the first end 12 can bepulled such that the constricting member 20 moves/rotates around thetissue 18 (from the position shown in FIGS. 12 and 13) until it is inclose proximity to the suture anchor 2 or other optimal location as maybe decided by the user. While first end 12 is pulled, positioning loop40 becomes smaller (compare FIG. 13 with FIG. 15). Constricting member20 can be a relatively bulky construct, and a user may prefer to moveconstricting member 20 towards first body (B) (within a bone hole 26) ina less irritating position to the patient. Finally, excess suturematerial 6 from the first end 12 and the second end 13 can be excisednear the bone 16 to produce the end result of the locking sutureconstruct 10 surrounding the tissue 18 (second body (A)) and the sutureanchor 2 (first body (B)) in a post-bone installation position andconfiguration as shown in FIG. 16. Thus, the tissue 18 is held in aposition relative to the suture anchor 2 by the locking suture construct10. The relative position is ultimately secured with two loops, thefixation loop 30 and the positioning loop 40. The fixation loop 30 holdsthe tissue 18 (second body (A)) in relative position to the sutureanchor 2 (first body (B)), while the positioning loop 40 holds theconstricting member 20 in a desirable position such that irritation andtrauma is reduced.

However, if the constricting member 20 moves or is rotated to anundesirable or non-optimal position with respect to the tissue 18 andthe suture anchor 2, the locking suture construct 10 can be repositionedas long as the first end 12 and second end 13 have not been cut. Toreposition the locking suture construct 10, the control line 11 ispulled and the constricting member 20 moves/rotates away from the sutureanchor 2 and back toward the tissue 18. As the constricting member 20moves/rotates, the perimeter of the locking loop 15 grows (essentiallyperforming the above referenced steps in reverse order). This allows thelocking suture construct 10 to be repositioned in a desirable area, forexample, an area where the constricting member 20 will cause lessirritation or trauma to the surrounding tissue or bone. In accordancewith an alternative embodiment, second end 13 can be pulled instead ofcontrol line 11 to obtain the same results as discussed in thisparagraph.

In an alternative embodiment shown in FIGS. 17-20, the illustratedconstricting member of the locking suture construct 10′ is notadjustable and is instead a fixed constricting member (e.g., fixedconstricting member 20″ shown in FIG. 3E) to be used in conjunction witha threader 21.

Referring next to FIG. 18, the threader 21 is shown inserted through thehollow section 23 of the fixed constricting member 20″. The eyelet 22 ofthe threader 21 extends through the fixed constricting member 20. Asshown in the depicted embodiment, the control line 11 is being pulledthrough the eyelet 22 of the threader 21. Thereafter, with reference toFIG. 19, the threader 21 is pulled away from the fixed constrictingmember 20, such that the eyelet 22 holding the control line 11 is fullypulled through the fixed constricting member 20. Just as shown in anddescribed with respect to FIG. 8, FIG. 20 depicts the control line 11pulled through the constricting member 20 to create the locking loop 15.The steps shown and described with respect to FIGS. 8-16 apply equallyto the fixed constricting member 20″ alternative embodiment.

Referring back to FIGS. 3C-3D, an alternative embodiment regarding thelocking splice 20′ constricting member construct is shown. FIG. 21 showsa top perspective view schematic representation of the locking sutureconstruct 10″ using the locking splice 20′ according to this alternativeembodiment. In the depicted embodiment, the second body (A) is in afirst position relative to the first body (B). As shown, both the firstend 12 and the second end 13 have been pulled through the locking loop15.

Referring back to FIG. 3C, there is shown a magnified view of thelocking splice construct 20′. In the depicted embodiment, the lockingsplice construct 20′ is formed in a fourth limb 4′, which is in thesecond end 13 of the suture material 6, similar to that shown in FIG. 1and also shown in FIG. 21. The locking loop 15 has a first limb 1′ and asecond limb 2′, which extend through the locking splice construct 20′.In addition, the first end 12 of the suture material 6 which has beenpassed through the locking loop 15, extends through the locking spliceconstruct 20′ as a third limb 3′ on the same side of the second body (A)as the first limb 1′ and the second limb 2′. The fourth limb 4′ is theonly portion of suture material 6 shown on the opposing side of thesecond body (A). Ultimately, when the perimeter of the locking loop 15is reduced to the minimum working perimeter, the first limb 1′ and thesecond limb 2′ are pulled through the locking splice construct 20 untilthe locking loop 15 is tightly wrapped around the third limb 3′ and thefourth limb 4′, as shown in FIG. 3D. The steps shown and described withrespect to FIGS. 8-16 apply equally to the locking splice 20′alternative embodiment.

While embodiments of the present invention has been particularly shownand described with reference to certain exemplary embodiments, it willbe understood by one skilled in the art that various changes in detailmay be effected therein without departing from the spirit and scope ofthe invention as defined by claims that can be supported by the writtendescription and drawings. Further, where exemplary embodiments aredescribed with reference to a certain number of elements it will beunderstood that the exemplary embodiments can be practiced utilizingeither less than or more than the certain number of elements.

What is claimed is:
 1. A method of securing a first body in relativeposition to a second body, the method comprising the steps of: providinga locking suture construct having suture material with a first end and asecond end, each attached to a first body in a slidable manner, aconstricting member formed in the second end of the suture material, anda bight in the suture material between the first end and the second end;pulling the bight through the constricting member around a second bodyto create a locking loop; passing the first end and the second end ofthe suture material through the locking loop; pulling the locking loopwhile holding the first end in a fixed position to increase a perimeterof the locking loop to a first predetermined size, pulling on the firstend to decrease the perimeter of the locking loop to a secondpredetermined size smaller than the first predetermined size, andpulling on the first end after the locking loop reaches the secondpredetermined size to move the constricting member past the second bodytoward the first body to a first position.
 2. The method of claim 1,further comprising the step of excising a portion of the first end andthe second end.
 3. The method of claim 1, further comprising the step ofpulling the bight until the constricting member moves away from thefirst body and back toward the second body to a second position.
 4. Themethod of claim 1, wherein the step of pulling the first end until theconstricting member moves around the second body toward the first bodyto a first position reduces the perimeter of the locking loop.
 5. Themethod of claim 1, wherein the locking loop squeezes the first end andthe second end of the suture material when in the second predeterminedsize.
 6. The method of claim 1, further comprising the step of loadingthe first body onto an inserter.
 7. The method of claim 1, furthercomprising steps of: inserting a threader through the constrictingmember; and pulling the bight through an eyelet of the threader.
 8. Themethod of claim 7, wherein the step of pulling the bight through theconstricting member around the second body to create the locking loopincludes the step of pulling the threader out of and away from theconstricting member.